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WO2016167197A1 - Dispositif médical - Google Patents

Dispositif médical Download PDF

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Publication number
WO2016167197A1
WO2016167197A1 PCT/JP2016/061589 JP2016061589W WO2016167197A1 WO 2016167197 A1 WO2016167197 A1 WO 2016167197A1 JP 2016061589 W JP2016061589 W JP 2016061589W WO 2016167197 A1 WO2016167197 A1 WO 2016167197A1
Authority
WO
WIPO (PCT)
Prior art keywords
blade
living tissue
medical device
incision
treatment
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/JP2016/061589
Other languages
English (en)
Japanese (ja)
Inventor
武井　祐介
千博 田中
智之 高篠
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Olympus Corp
Original Assignee
Olympus Corp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Olympus Corp filed Critical Olympus Corp
Priority to EP16779988.1A priority Critical patent/EP3284431A4/fr
Priority to CN201680021868.7A priority patent/CN107530120B/zh
Priority to JP2016556336A priority patent/JP6125117B2/ja
Publication of WO2016167197A1 publication Critical patent/WO2016167197A1/fr
Priority to US15/726,735 priority patent/US20180036023A1/en
Anticipated expiration legal-status Critical
Priority to US16/432,235 priority patent/US20190282252A1/en
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/2812—Surgical forceps with a single pivotal connection
    • A61B17/282—Jaws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/08—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by means of electrically-heated probes
    • A61B18/082—Probes or electrodes therefor
    • A61B18/085—Forceps, scissors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/149—Probes or electrodes therefor bow shaped or with rotatable body at cantilever end, e.g. for resectoscopes, or coagulating rollers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/32056—Surgical snare instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00601—Cutting
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00607—Coagulation and cutting with the same instrument
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/0063—Sealing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/1206—Generators therefor
    • A61B2018/1246—Generators therefor characterised by the output polarity
    • A61B2018/126—Generators therefor characterised by the output polarity bipolar
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
    • A61B2018/1455—Probes having pivoting end effectors, e.g. forceps including means for cutting having a moving blade for cutting tissue grasped by the jaws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
    • A61B2018/1457—Probes having pivoting end effectors, e.g. forceps including means for cutting having opposing blades cutting tissue grasped by the jaws, i.e. combined scissors and pliers

Definitions

  • the present invention relates to a medical device that can be treated while holding a living tissue.
  • the treatment portion of the treatment tool disclosed in Japanese Patent Laid-Open No. 2001-198137 is formed so that the position closer to the gripping surface of the other jaw among the gripping surfaces of one jaw is sharper.
  • the treatment unit transfers heat to the gripping surface in a state where pressure is applied to the living tissue to be incised at a sharp portion of the gripping surface of one jaw, and solidifies (seals) the living tissue to be treated. An incision is made.
  • the present invention makes it possible to grasp a large blood vessel or a large biological tissue that cannot be cut at a time, while suppressing the leaving of a grip mark when a treatment is not required just by grasping the biological tissue. It is an object of the present invention to provide a medical device that can be treated while preventing bleeding even when a living tissue is treated such as coagulation (sealing) or incision divided into multiple times.
  • a medical device is a position where a jaw provided with a gripping portion and the gripping portion can be approached and separated, extend from a distal end portion to a proximal end portion, and face the gripping portion. And a blade having a radius of curvature of the top portion at the distal end portion larger than a radius of curvature of the top portion at the proximal end portion.
  • FIG. 1 is a schematic view showing a treatment system according to the first to third embodiments.
  • FIG. 2 is a schematic diagram illustrating a treatment unit of the treatment tool of the treatment system according to the first embodiment.
  • FIG. 3A shows a state in which a living tissue is gripped between the sealing region of the blade of the first treatment piece and the blade receiver of the second treatment piece of the treatment portion of the treatment instrument according to the first embodiment.
  • FIG. 3 is a schematic cross-sectional view taken along line 3A-3A.
  • FIG. 3B shows a state in which a living tissue is grasped between the incision region of the blade of the first treatment piece of the treatment portion of the treatment instrument according to the first embodiment and the blade receiver of the second treatment piece.
  • FIG. 3 is a schematic cross-sectional view taken along line 3B-3B.
  • FIG. 4 shows a sealing region formed at the distal end portion of the blade of the first treatment piece of the treatment portion of the treatment instrument according to the first embodiment, and an incision region formed at the proximal end side of the sealing region. It is a schematic perspective view.
  • FIG. 5A shows a state in which a living tissue is grasped between the sealing region of the blade of the treatment portion of the treatment instrument according to the first embodiment and the grasping portion of the blade receiver as viewed from the direction of the arrow 5A in FIG. 5B.
  • FIG. 5B shows a state in which a living tissue is grasped between the sealing region of the blade of the treatment portion of the treatment instrument according to the first embodiment and the grasping portion of the blade receiver as viewed from the direction of the arrow 5B in FIG. 5A.
  • FIG. FIG. 6 is a schematic perspective view showing a state in which a living tissue is gripped between the blade sealing region of the treatment portion of the treatment instrument according to the first embodiment and the grip portion of the blade receiver.
  • 7A shows a state in which a living tissue is gripped between the blade sealing area and the incision area of the treatment portion of the treatment instrument according to the first embodiment and the blade receiver gripping direction in the direction of arrow 7A in FIG. 7B. It is the schematic seen from.
  • FIG. 7A shows a state in which a living tissue is gripped between the blade sealing area and the incision area of the treatment portion of the treatment instrument according to the first embodiment and the blade receiver gripping direction in the direction of arrow 7A in FIG. 7B. It is the schematic seen
  • FIG. 7B shows a state in which a living tissue is gripped between the sealing region and the incision region of the blade of the treatment portion of the treatment instrument according to the first embodiment and the grip portion of the blade receiver in the direction of the arrow 7B in FIG. 7A.
  • FIG. 8 is a schematic view showing a living tissue incised while sealing the living tissue by heating the heater and transferring the heat to the blade in a state where the living tissue is gripped in the state shown in FIGS. 7A and 7B.
  • FIG. 9A shows a state in which a blood vessel is gripped between the sealing region and the incision region of the blade of the treatment portion of the treatment instrument according to the first embodiment and the grip portion of the blade receiver from the direction of the arrow 9A in FIG.
  • FIG. 9B shows a state in which a blood vessel is gripped between the blade sealing region and the incision region of the treatment portion of the treatment instrument according to the first embodiment and the grip portion of the blade receiver from the direction of the arrow 9B in FIG. 9A.
  • FIG. FIG. 10 is a schematic view showing a blood vessel incised while sealing the blood vessel by heating the heater and transferring the heat to the blade in a state where the blood vessel is grasped in the state shown in FIGS. 9A and 9B.
  • FIG. 11 is formed on the distal end portion of the blade of the first treatment piece of the treatment portion of the treatment instrument according to the first modification of the first embodiment, and on the proximal end side of the seal region.
  • FIG. 12 is a schematic perspective view showing a state in which a non-slip is formed in the sealing region formed at the tip of the blade of the first treatment piece of the treatment portion of the treatment tool according to the second modification of the first embodiment.
  • FIG. 13 is a schematic cross-sectional view taken along line 3A-3A in FIG. 2, showing a treatment portion of the treatment tool of the treatment system according to the third modification example of the first embodiment.
  • FIG. 14 is a schematic view showing a state where the second treatment piece is formed as a seesaw jaw in the treatment portion of the treatment tool of the treatment system according to the fourth modification of the first embodiment.
  • FIG. 12 is a schematic perspective view showing a state in which a non-slip is formed in the sealing region formed at the tip of the blade of the first treatment piece of the treatment portion of the treatment tool according to the second modification of the first embodiment.
  • FIG. 13 is a schematic cross-sectional view taken along line 3A-3A in FIG. 2, showing a treatment portion of the treatment tool of the treatment system according to
  • FIG. 15A shows a state in which a living tissue is gripped between the sealing region of the blade of the first treatment piece of the treatment portion of the treatment device of the treatment system according to the second embodiment and the blade receiver of the second treatment piece. It is a schematic cross-sectional view.
  • FIG. 15B is a schematic diagram illustrating a state in which a living tissue is grasped between the incision region of the blade of the first treatment piece and the blade receiver of the second treatment piece of the treatment unit of the treatment tool of the treatment system according to the second embodiment.
  • FIG. FIG. 16 is a schematic perspective view illustrating a first treatment piece of a treatment portion of the treatment tool of the treatment system according to the second embodiment.
  • FIG. 17A is a schematic perspective view illustrating a modification of the first treatment piece of the treatment portion of the treatment tool of the treatment system according to the second embodiment.
  • FIG. 17B is a schematic cross-sectional view taken along line 3A-3A in FIG. 2, showing a treatment portion of the treatment tool of the treatment system according to the modification of the second embodiment.
  • FIG. 18 is a schematic cross-sectional view showing a state in which a living tissue is grasped between the blade of the first treatment piece and the blade receiver of the second treatment piece of the treatment portion of the treatment tool of the treatment system according to the third embodiment.
  • a treatment system (energy treatment system) 10 includes a treatment tool (energy treatment tool) 12 as a medical device and a control unit 14 including an energy source 14a.
  • the treatment instrument 12 includes an insertion portion 22 and an operation portion 24 provided at a proximal end portion of the insertion portion 22.
  • the operation unit 24 includes an operation unit main body 26 and a knob 28 that operates a treatment unit 32 described later of the insertion unit 22.
  • the operation unit body 26 has one end 26a and the other end 26b.
  • One end 26 a of the operation portion main body 26 is connected to a proximal end of a sheath 34 described later of the insertion portion 22.
  • the knob 28 can be moved toward and away from the other end 26b of the operation portion main body 26.
  • the operation unit main body 26 is formed in a substantially L shape, but the shape of the operation unit main body 26 can be selected as appropriate.
  • the insertion part 22 has a treatment part 32 and a sheath 34.
  • the treatment portion 32 is provided at the distal end portion of the sheath 34 of the insertion portion 22.
  • the sheath 34 is provided at the proximal end portion of the treatment portion 32 and is connected to one end 26 a of the operation portion main body 26 of the operation portion 24.
  • the treatment portion 32 of the insertion portion 22 is provided on the first jaw 42 and the first and second jaws 42 and 44 that are relatively opened and closed by the operation of the operation portion 24.
  • a blade (first pressure applying body) 46 and a blade receiver (second pressure applying body) 48 provided on the second jaw 44 are provided.
  • the first jaw 42 is provided with a blade 46 to form a first treatment piece 52
  • the second jaw 44 is provided with a blade receiver 48 to form a second treatment piece 54.
  • the first jaw 42 is provided with the blade receiver 48 to form the first treatment piece 52
  • the second jaw 44 is provided with the blade 46 to form the second treatment piece 54. It is.
  • the first jaw 42 is integrally fixed to the sheath 34.
  • the second jaw 44 rotates around the axis of the pivot shaft 50 and approaches the first jaw 42.
  • the second jaw 44 rotates around the axis of the pivot shaft 50 and separates from the first jaw 42. That is, here, the description will be made assuming that the second jaw 44 can approach and separate from the first jaw 42 by an appropriate operation of the operation unit 24.
  • the description of the structure related to the proximity and separation of the second jaw 44 with respect to the first jaw 42 is omitted here.
  • the first jaw 42 can be rotated at the distal end of the sheath 34
  • the second jaw 44 can be rotated at the distal end of the sheath 34
  • the first and second jaws 42, 44 can be simultaneously moved relative to each other. It is also preferable that it is formed to be movable so as to be close to and away from each other.
  • the first and second jaws 42 and 44 are preferably formed of a rigid material such as a stainless alloy material. It is preferable that the outer surfaces of the first and second jaws 42 and 44 are electrically insulated.
  • the sheath 34 is preferably formed in a cylindrical shape with a rigid material such as a stainless alloy material, and the surface thereof is preferably electrically insulated.
  • the blade 46 is formed of a material having good thermal conductivity such as a copper alloy material or an aluminum alloy material. Moreover, it is preferable that the blade receiver 48 is made of a material having electrical insulation properties such as PTFE and heat resistance. The blade receiver 48 is also preferably formed so as to be appropriately elastically deformable by the pressure applied from the living tissue LT when the living tissue LT is gripped between the blade receiver 46 and the blade 46.
  • the blade 46 is in a position close to the second jaw 44 in the first jaw 42.
  • the blade receiver 48 is located at a position close to the first jaw 42 in the second jaw 44. Therefore, the blade receiver 48 comes close to the blade 46 due to the proximity of the second jaw 44 to the first jaw 42.
  • the blade receiver 48 is separated from the blade 46 by the separation of the second jaw 44 from the first jaw 42.
  • a heater 56 is disposed between the first jaw 42 and the blade 46 as a heat source. For this reason, the energy source 14a of the control unit 14 is controlled, and the blade 46 is heated by supplying appropriate energy from the energy source 14a to the heater 56. That is, the temperature of the blade 46 is increased from the sealing region 62 to the incision region 64 from the distal end to the proximal end of the top portion 46 a by heat transfer from the heater 56. It is preferable that the heater 56 is not embedded between the first jaw 42 and the blade 46 but the heater 56 is embedded in the blade 46.
  • the heat insulating material 58 which has heat resistance with respect to the temperature exceeding 300 degreeC, for example, and low heat conductivity is arrange
  • the first jaw 42 ensures a distance between the stainless steel alloy material and the heater 56 with a material having a lower thermal conductivity than the stainless steel alloy material such as PTFE material, for example, with the heater 56. It is arranged as a spacer. For this reason, heat from the heater 56 is prevented from being directly transferred to the surface of the first jaw 42.
  • an air layer or the like is formed instead of the heat insulating material 58. That is, an object is not necessarily disposed between the heater 56 and the first jaw 42.
  • the blade 46 has a top 46 a that extends from the distal end to the proximal end and includes a ridge at a position facing the blade receiver 48 of the second jaw 44.
  • the blade 46 has a longitudinal axis L extending between the distal end portion (sealing region 62) and the proximal end portion (incision region 64).
  • the longitudinal axis L of the blade 46 extends along the top 46a.
  • the top 46a is continuously extended in parallel or substantially parallel to the longitudinal axis L. Therefore, when the second treatment piece 54 is closed with respect to the first treatment piece 52 and the top portion 46a of the blade 46 is brought close to the gripping portion 48a of the blade receiver 48, the top portion 46a of the blade 46 is based on the tip thereof. It is preferable to abut the grip portion 48a of the blade receiver 48 over substantially the entire end.
  • the blade 46 is preferably formed such that the length along the longitudinal axis L is larger than the width W in the width direction perpendicular to the longitudinal axis L. As shown in FIGS. 3A and 3B, the cross-sectional shape of the blade 46 is preferably formed symmetrically with respect to the virtual plane S including the longitudinal axis L and extending in the opening / closing direction of the second jaw 44, for example. .
  • the blade 46 grips the living tissue LT at the distal end along the longitudinal axis L in cooperation with the gripping portion 48a of the blade receiver 48, and seals the living tissue LT in cooperation with the gripping portion 48a by adding energy. It has the sealing area
  • the blade 46 has an incision region (second pressure applying portion) 64 formed continuously along the longitudinal axis L and continuously with the sealing region 62 on the proximal end side of the sealing region 62.
  • the incision region 64 grasps the living tissue LT in cooperation with the grasping portion 48a, and incises while sealing the living tissue LT in cooperation with the grasping portion 48a by adding energy.
  • an incision region 64 for incising the living tissue LT is formed from the proximal end of the sealing region 62 to the proximal end portion of the blade 46.
  • the length of the blade 46 is, for example, about 18 mm to 20 mm.
  • the length along the longitudinal axis L in the sealing region 62 is shorter than the length along the longitudinal axis L in the incision region 64. That is, of the blade 46, the length along the longitudinal axis L at the distal end portion (sealing region 62) is the base end of the distal end portion (sealing region 62) and the proximal end portion of the proximal end portion (incision region 64). Shorter than the length along the longitudinal axis L.
  • the length along the longitudinal axis L in the sealing region 62 is preferably about 0.5 mm to 2.5 mm.
  • the treatment portion 32 and the sheath 34 are formed in a size that allows a trocar (not shown) having an appropriate inner diameter to pass therethrough as a whole.
  • the width W of the blade 46 is about 4 mm to 5 mm.
  • the treatment part 32 and the sheath 34 are not restricted to the form penetrated by the trocar.
  • the shape of the scissors-type device used in a laparotomy without using a trocar may be appropriately modified.
  • a gripping portion 48 a is provided at the distal end portion of the treatment portion 32, a handle is provided at the proximal end portion of the treatment portion, and an intermediate portion of the treatment portion 32 rotates with respect to the sheath 34 via the pivot shaft 50.
  • the incision region 64 has an incision part (edge part) 72 for incising the living tissue LT and sealing parts 74a and 74b for sealing the living tissue LT.
  • the top 46 a of the sealing region 62 at the distal end of the blade 46 and the top 46 a of the incision region 64 on the proximal end side of the sealing region 62 are on the longitudinal axis L.
  • the incision 72 is at the top 46a.
  • the top 46 a is a ridge extending along the longitudinal axis L.
  • the apex of the top portion 46a forms a ridge line extending along the longitudinal axis L as can be seen from FIGS. 3A and 3B. In the incision region 64, this ridge line becomes the incision 72.
  • the radius of curvature Rd of the top 46a at the sealing region 62 that is, the tip of the blade 46 is larger than the radius of curvature Rp of the top 46a at the incision region 64, that is, the base end of the blade 46.
  • the tip 46a of the blade 46 that is, the top 46a in the sealing region 62 is preferably formed in an arc shape in cross section.
  • blade 46 has an arc-shaped surrounding surface.
  • the radii of curvature Rd and Rp of the top portion 46a are formed so as to decrease from the distal end portion of the blade 46 toward the proximal end side.
  • the ridge of the sealing region 62 of the blade 46 is formed in an obtuse shape, and the ridge of the incision region 64 is formed in a sharper shape than the sealing region 62. That is, the ridge in the sealing region 62 of the blade 46 is formed to have an appropriate width in the width direction orthogonal to the longitudinal axis L. The ridge in the incision region 64 of the blade 46 is formed to have a width sufficiently smaller than the width of the sealing region 62 in the width direction orthogonal to the longitudinal axis L.
  • the radius of curvature Rd of the tip of the blade 46, that is, the sealing region 62 is the same as that of the gripping portion 48 a facing the sealing region 62 of the blade receiver 48 by adding energy (here, thermal energy from the heater 56) to the top 46 a.
  • the living body LT is formed in such a size that it can coagulate (can be sealed) in cooperation.
  • the top portion 46a that is, the incision (edge) 72 in the incision region 64 is defined by two planar sealing portions 74a and 74b such as a substantially planar shape.
  • the radius of curvature Rp of the portion of the incision region 64 including the incision portion 72 cooperates with the opposite portion of the blade receiver 48 by adding energy (in this embodiment, thermal energy from the heater 56) to the top portion 46a, that is, the incision portion 72. It is formed in a size that allows the living tissue LT to be cut open.
  • the incision 72 is formed as a sharper portion than the sealing region 62. Here, the incision 72 is formed in a straight line. For this reason, the width of the incision 72 is sufficiently smaller than the width W of the blade 46.
  • the blade receiver 48 has a grip portion 48a for gripping the living tissue LT.
  • the grip part 48a is substantially planar. It is also preferable that the grip portion 48a is a curved surface such as an arc. In a state where the second jaw 44 is brought close to the first jaw 42, the blade 46 is close to the blade receiver 48, and the grip portion 48 a is in contact with the top portion 46 a of the blade 46.
  • the energy source 14 a of the control unit 14 is electrically connected to the heater 56 through the operation unit main body 26 of the operation unit 24 and the sheath 34 of the insertion unit 22.
  • the control unit 14 has a switch unit 16.
  • the control unit 14 is connected to the switch unit.
  • the switch unit 16 for example, a foot switch shown in FIG. 1 or a hand switch (not shown) provided in the operation unit 24 is used.
  • the control unit 14 controls the energy source 14a so that the temperature of the heater 56 is increased from, for example, about 200 ° C. to about 300 ° C. within a few seconds after the pressing of the pressing pad 16a of the switch unit 16.
  • the second jaw 44 is appropriately operated with respect to the first jaw 42, and the living tissue LT is gripped by the distal end portion of the treatment portion 32.
  • the living tissue LT is gripped in cooperation with the sealing region 62 of the blade 46 and the gripping portion 48a of the blade receiver 48.
  • the living tissue LT is grasped in a planar shape defined by the length along the longitudinal axis L of the sealing region 62 and the appropriate width of the top portion 46a orthogonal to the longitudinal axis L.
  • the sealing region 62 is formed as a curved surface such as an arc.
  • the blade 46 applies the highest pressure to the living tissue LT at the center in the width direction. Note that the sealing region 62 of the blade 46 does not apply pressure to the living tissue LT so as to cut the living tissue LT.
  • the length along the longitudinal axis L in the sealing region 62 is, for example, about 2 mm.
  • the width of the top portion 46a that contacts the living tissue LT in the sealing region 62 is, for example, about 1 mm to several mm (the maximum width W of the blade 46 is less than or equal to). For this reason, the contact portion between the living tissue LT and the sealing region 62 of the blade 46 has a planar shape.
  • the operation unit 24, that is, the treatment instrument 12 is moved in a state where the living tissue LT is held between the sealing region 62 at the distal end portion of the blade 46 and the holding portion 48 a of the blade receiver 48, the living tissue LT is pulled. Can be.
  • the living tissue LT between the sealing region 62 at the tip of the blade 46 and the gripping portion 48a of the blade receiver 48 is gripped not in a local manner but in a planar shape. For this reason, after once grasping the living tissue LT between the sealing region 62 and the grasping portion 48a of the blade receiver 48, when the grasped living tissue LT is released, a mark of grasping is left on the grasped portion, It is prevented as much as possible to cause damage that causes necrosis of the gripped part.
  • the heater 56 When energy is supplied from the energy source 14a to the heater 56 in a state where the living tissue LT is gripped between the sealing region 62 and the gripping portion 48a of the blade receiver 48, the heater 56 generates heat. At this time, the heater 56 is heated from room temperature to, for example, about 200 ° C. to about 300 ° C. within a few seconds by the energy output from the energy source 14 a while being controlled by the control unit 14. For this reason, heat is transferred from the heater 56 toward the top 46 a of the blade 46. At this time, since the living tissue LT is in contact with the sealing region 62 in a planar shape, the living tissue LT is heated in a planar shape.
  • the living tissue LT is heated in a planar shape at the top 46a of the sealing region 62, the heated portion is sealed (solidified) in a planar shape.
  • the controller 14 controls the output of energy from the energy source 14a to the heater 56 so that the heater 56 is heated from, for example, about 200 ° C. to about 300 ° C. and then stopped in about several seconds.
  • the living tissue LT When incising the living tissue LT, as shown in FIGS. 7A and 7B, the living tissue LT is held by the sealing region 62 and the holding portion 48 a of the blade receiver 48 facing the sealing region 62, and the sealing region 62.
  • the incision region 64 formed continuously to the incision region 64 and the gripping portion 48a of the blade receiver 48 facing the incision region 64 are gripped.
  • the living tissue LT between the sealing region 62 and the grip portion 48a of the blade receiver 48 is solidified as described above.
  • the incision 72 in the incision region 64 is formed as a sharper portion than the sealing region 62. For this reason, in the incision region 64, a greater pressure is applied to the part of the living tissue LT that is in contact with the incision 72 than the part in which the sealing parts 74a and 74b are in contact.
  • the part of the living tissue LT that has contacted the incision 72 is incised by the incision 72 by local pressure and heat, and also contacts the sealing portions 74a and 74b adjacent to the incision 72.
  • the part is sealed with heat.
  • the incision region 64 is incised and sealed, that is, coagulated, at substantially the same time. Therefore, the incision region 64 is incised while sealing (coagulating) the living tissue LT without bleeding.
  • a cut portion 65 is formed at a portion of the living tissue LT that is sandwiched between the incision 72 of the blade 46 and the proximal end of the blade receiver 48.
  • the distal end of the incision region 64 coincides with the proximal end of the sealing region 62. Therefore, the incision region 64 is incised while sealing (coagulating) the living tissue LT at the tip of the incision region 64. Therefore, as shown in FIG. 8, when the living tissue LT is incised, a region C sealed in a substantially U shape is formed in the living tissue LT. Thereby, a sealing portion (tip seal margin) 65C for sealing the living tissue LT is formed on the distal end side of the cut portion 65 of the living tissue LT in the longitudinal direction (living tissue LT) of the treatment portion 32.
  • the second jaw 44 When it is desired to extend the cut portion 65 of the living tissue LT shown in FIG. 8 to separate the living tissue LT into two, the second jaw 44 is opened with respect to the first jaw 42, and the treatment portion 32 is moved along the longitudinal axis L. Advance relative to the living tissue LT.
  • the living tissue LT is gripped by the sealing region 62 and the gripping portion 48a of the blade receiver 48 facing the sealing region 62, and an incision region 64 formed continuously with the sealing region 62 and a blade facing the incision region 64
  • the grip 48 is gripped by the grip 48 a. Then, as described above, an incision is made while sealing (coagulating) the living tissue LT. In this manner, the living tissue LT is cut while being sealed, and the living tissue LT is separated into two.
  • a treatment performed by grasping a blood vessel V having a diameter (thickness) larger than the total length TL in the longitudinal direction of the second jaw 44 as a treatment target will be described below.
  • FIGS. 9A and 9B when grasping a blood vessel V having a diameter larger than the total length TL of the second jaw 44, even if the blood vessel V is grasped between the first jaw 42 and the second jaw 44, the blood vessel The blade receiver 48 of the second jaw 44 cannot be brought into contact at once over the entire width of the blood vessel V in the radial direction of V. For this reason, in a state in which the blood vessel V is gripped between the first jaw 42 and the second jaw 44, the blade receiver 48 contacts only a part of the blood vessel V in the radial direction, not the entire width thereof.
  • the incision 72 of the blade 46 contacts the proximal end of the blade receiver 48. Therefore, in a state where the blood vessel V is gripped between the first jaw 42 and the second jaw 44, the blood vessel V acts on a portion sandwiched between the incision 72 of the blade 46 and the proximal end portion of the blade receiver 48. Pressure increases. For this reason, heat is radiated from the blade 46 while the blood vessel V is gripped between the first jaw 42 and the second jaw 44, so that the incision 72 and the blade of the blade 46 in the blood vessel V are caused by pressure and heat. A portion sandwiched between the base end portion of the receptacle 48 is cut (incised).
  • a cut portion 65 is formed at a portion of the blood vessel V that is sandwiched between the incision 72 of the blade 46 and the proximal end of the blade receiver 48. Further, a cut-away portion 63 is formed at a portion where the tip of the blade receiver 48 of the blood vessel V does not contact in the radial direction of the blood vessel V.
  • the planar first sealing portion 74 a and the second sealing portion 74 b are respectively relative to the proximal end portion of the blade receiver 48. They are separated and do not come into contact. Therefore, the first sealing portion 74a located on one side of the incision portion 72 in the width direction of the first jaw 42 and the second sealing portion 74a located on the other side of the incision portion 72 in the width direction of the first jaw 42. In the sealing part 74 b, the pressure acting on the blood vessel V between the first jaw 42 and the second jaw 44 is smaller than that of the incision part 72.
  • sealing portions (width direction seal margins) 65A and 65B in which the blood vessel V is sealed are respectively provided on both sides of the cut portion 65 of the blood vessel V in the width direction of the treatment portion 32 (the extending direction of the blood vessel V). It is formed.
  • the sealing portions 65A and 65B even when the blood vessel V is cut, bleeding from both sides of the cut portion 65 in the width direction of the treatment portion 32 is effectively prevented.
  • the dimension B1 of the second jaw 44 in the width direction is 4 mm or more and 5 mm or less
  • the dimension B2 of the incision 72 in the width direction of the treatment section 32 is 0. .5 mm or more and 1 mm or less.
  • each dimension (one corresponding to S1 and S2) of the sealing portions 65A and 65B in the extending direction of the blood vessel V is, for example, not less than 0.5 mm and not more than 2.5 mm.
  • the incision 72 of the blade 46 contacts the distal end of the blade receiver 48, but the distal end of the incision 72 is incised. Since it is formed to be blunt compared to the proximal end portion of the portion 72, the proximal end of the incision portion 72 and the blade receiver 48 is located in the region of the blood vessel V sandwiched between the incision portion 72 and the distal end portion of the blade receiver 48. Compared with the part pinched
  • a sealing portion (tip seal margin) 65C for sealing the blood vessel V is provided between the cut portion 65 and the uncut portion 63 of the blood vessel V in the longitudinal direction of the treatment portion 32 (the radial direction of the blood vessel V). It is formed.
  • the cut portion of the blood vessel V is cut.
  • a sealing portion (tip seal margin) 65 ⁇ / b> C is formed between 65 and the uncut portion 63.
  • the second jaw 44 When it is desired to extend the cut portion 65 of the blood vessel V shown in FIG. 10 to separate the blood vessel V into two, the second jaw 44 is opened with respect to the first jaw 42, and the treatment portion 32 is moved along the longitudinal axis L to the blood vessel V. Move forward against.
  • the blood vessel V is gripped by the sealing region 62 and the grip portion 48 a of the blade receiver 48 facing the sealing region 62, and the blade receiver facing the incision region 64 and the incision region 64 formed continuously from the sealing region 62. It is gripped by 48 gripping portions 48a.
  • the blood vessel V is incised while being sealed (coagulated). In this way, the blood vessel V is incised while being sealed, and the blood vessel V is separated into two.
  • the treatment system 10 As described above, according to the treatment system 10 according to this embodiment, particularly the treatment tool 12 as a medical device, the following can be said.
  • the living tissue LT is grasped between the sealing region 62 of the blade 46 and the grasping portion 48a of the blade receiver 48. That is, the living tissue LT can be grasped using only the distal end portion of the treatment portion 32. At this time, the sealing region 62 of the blade 46 and the gripping portion 48a of the blade receiver 48 grip the living tissue LT in a planar shape. For this reason, according to this treatment tool 12, it is possible to grasp the living tissue LT while suppressing as much as possible the remaining trace of the grasping when the living tissue LT is released from the treatment portion 32.
  • the incision region 64 of the blade 46 can exhibit the function of the incision portion 72 while exhibiting the sealing function of the sealing portions 74a and 74b. For this reason, treatments such as coagulation and incision can be performed using the entire treatment section 32.
  • the example in which the cross section of the sealing region 62 of the blade 46 is formed in a substantially arc shape and the surface of the sealing region 62 is smooth has been described.
  • a non-slip 78 is formed in the sealing region 62 so as to prevent the living tissue LT from slipping due to, for example, satin or unevenness.
  • the blade receiver 48 is formed with a non-slip (not shown) at a portion facing the sealing region 62 of the blade 46 so as to prevent the living tissue LT from slipping due to, for example, satin or unevenness. Is preferred.
  • the shapes of the sealing region 62 and the incision region 64 of the blade 46 are not limited to the shapes shown in FIGS. 3A to 4.
  • a ridge line extending from the sealing region 62 to the incision region 64 may have a width.
  • the ridge line portion is formed by a plane or a curved surface close to a substantially plane (hereinafter, referred to as a plane), and the width of the plane in the sealing region 62 is larger than the width of the plane in the incision region 64.
  • a plane substantially plane
  • the ridge portion of the sealing region 62 is formed into a plane and the ridge of the incision region 64 is formed into the shape of FIG. 3B, the ridge line portion of the incision region 64 is formed into a plane and the ridge of the sealing region 62 is formed into the shape of FIG. Note that changes in can be made as appropriate.
  • the blade receiver 48 has a convex grip 48a extending along the longitudinal axis L. That is, the gripping portion 48a of the blade receiver 48 does not need to be formed as a flat surface.
  • the second treatment piece 54 has a blade receiver 48 supported by a support pin 82 so as to be rotatable with respect to the second jaw 44. That is, the second treatment piece 54 is also preferably formed as a so-called seesaw jaw. By grasping the living tissue LT in a state where the blade receiver 48 is appropriately rotated with respect to the second jaw 44, the grasping pressure of the living tissue LT between the blade 46 and the blade receiver 48 can be made uniform. it can.
  • the first treatment piece 52 is also formed as a so-called seesaw jaw.
  • This embodiment is a modification of the first embodiment including each modification.
  • the same members or members having the same functions as those described in the first embodiment are denoted by the same reference numerals as much as possible, and will be described in detail. Is omitted.
  • high-frequency energy is used instead of heat energy by the heater 56.
  • the blade 46 of the first treatment piece 52 shown in FIGS. 15A and 15B has conductivity, and functions as a first high-frequency electrode.
  • the blade receiver 48 of the second treatment piece 54 is provided with a pair of second high-frequency electrodes 104a and 104b.
  • the blade receiver 48 has electrical insulation.
  • the second high-frequency electrodes 104a and 104b are electrically connected to each other at the proximal end portion of the treatment portion 32, for example. Therefore, high-frequency energy is output between the blade (first high-frequency electrode) 46 and the second high-frequency electrodes 104a and 104b.
  • the blade 46 and the second high-frequency electrodes 104a and 104b may be formed of the same material, and it is also preferable to use materials having different characteristics such as a copper alloy and an aluminum alloy.
  • the edge part of the holding part 48a of the blade receiver 48 is formed flush with the mutually opposing edge parts of the second high-frequency electrodes 104a and 104b.
  • the center in the width direction of the grip portion 48a is formed in a curved shape in which the sealing region 62 of the top portion 46a of the blade 46 abuts in an arc shape with respect to the opposing edges of the second high-frequency electrodes 104a and 104b. . For this reason, the contact area between the sealing region 62 of the blade 46 and the gripping portion 48a of the blade receiver 48 can be increased.
  • the second high-frequency electrodes 104 a and 104 b of the second treatment piece 54 contact the blade 46 of the first treatment piece 52 with the second treatment piece 54 closed with respect to the first treatment piece 52.
  • the blade receivers 48 are spaced apart from each other in the width direction orthogonal to the longitudinal axis L so as not to contact.
  • the surfaces of the second high-frequency electrodes 104 a and 104 b of the second treatment piece 54 protrude slightly toward the first treatment piece 52 from the gripping portion 48 a of the blade receiver 48.
  • the distance Dd between the second high-frequency electrodes 104a and 104b at the position facing the sealing region 62 in the blade receiver 48 is between the second high-frequency electrodes 104a and 104b at the position facing the incision region 64. It is larger than the distance Dp. That is, between the pair of second high-frequency electrodes 104a and 104b, the distance Dd in the portion of the top portion 46a that faces the sealing region (tip portion) 62 is opposed to the incision region (base end portion) 64 of the top portion 46a. It is larger than the distance Dp in the part to be.
  • the longitudinal axis L is arranged at the midpoint of the distance Dd and the midpoint of the distance Dp. Therefore, as shown in FIGS. 15A and 15B, when the top 46a of the blade 46 is brought into contact with the blade receiver 48, the blade 46, that is, the first high-frequency electrode and the second high-frequency electrode 104a, 104b are separated from each other. In addition, the distance between the blade 46 and the second high frequency electrodes 104a and 104b can be reduced. Then, the living tissue LT can be easily brought into contact with both the blade 46 and the second high-frequency electrodes 104a and 104b of the blade receiver 48 with the second treatment piece 54 closed with respect to the first treatment piece 52. it can.
  • the energy source 14a is electrically connected to the blade 46, that is, the first high-frequency electrode and the second high-frequency electrodes 104a and 104b of the blade receiver 48, respectively. For this reason, when energy is supplied from the energy source 14a with the living tissue LT sandwiched between the blade 46 and the second high-frequency electrodes 104a and 104b of the blade receiver 48, the living tissue LT is treated by Joule heat. Can do.
  • the living tissue LT is in plane contact with the sealing region 62 including the top 46a of the blade 46. Therefore, as described in the first embodiment, the living tissue LT grasped between the sealing region 62 of the blade 46 and the grasping portion 48a of the blade receiver 48 rises in a planar shape by the action of high-frequency energy. Warm up. Thus, since the living tissue LT is heated in a planar shape at the top 46a of the sealing region 62, the heated portion is sealed (solidified) in a planar shape.
  • the living tissue LT is in contact with the incision region 64 including the top 46a of the blade 46. At this time, the living tissue LT is in contact with at least the incision 72 and a position in the vicinity of the incision 72 of the sealing portions 74a and 74b. For this reason, as described in the first embodiment, in the incision region 64, the part of the living tissue LT that contacts the incision 72 is subjected to local pressure and the action of Joule heat by high-frequency energy. In addition, the portion in contact with the sealing portions 74a and 74b adjacent to the incision 72 is sealed by Joule heat. For this reason, the incision region 64 is incised and sealed, that is, coagulated, at substantially the same time. Therefore, the incision region 64 is incised while sealing (coagulating) the living tissue LT without bleeding.
  • the energy supply method from the energy source 14a to the second high-frequency electrodes 104a and 104b of the blade 46 and the blade receiver 48 can be set as appropriate.
  • the energy source 14a is appropriately connected to the second high frequency electrodes 104a and 104b of the blade 46 and the blade receiver 48 according to a change in impedance of the living tissue LT between the second high frequency electrodes 104a and 104b of the blade 46 and the blade receiver 48, for example. Energy can be supplied and energy supply can be stopped.
  • the gripping portion 48a of the blade receiver 48 and the surfaces of the second high-frequency electrodes 104a and 104b are formed flush with each other. Therefore, when the second treatment piece 54 is closed with respect to the first treatment piece 52, the blade 46 of the first treatment piece 52 is prevented from coming into contact with the second high-frequency electrodes 104a and 104b. Note that the same effect can be obtained even if the gripping portion 48a of the blade receiver 48 is protruded from the surfaces of the second high-frequency electrodes 104a and 104b.
  • the distance Dd between the second high-frequency electrodes 104a and 104b at a position facing the sealing region 62 and the second high-frequency electrode 104a at a position facing the incision region 64. , 104b is preferably the same distance Dp.
  • This embodiment is a modification of the first and second embodiments including each modification, and the same reference numerals are given to the same members or members having the same functions as those described in the first and second embodiments. The detailed description is omitted.
  • the first treatment piece 52 is formed to transfer heat from the heater 56 while using the blade 46 as a high-frequency electrode.
  • control unit 14 can incise while sealing the living tissue LT by controlling the energy source 14a and appropriately adding energy to the living tissue LT.
  • the living tissue LT is gripped between the sealing region 62 and the gripping portion 48a of the blade receiver 48 facing the sealing region 62 without applying energy to the living tissue LT, and the living tissue LT is pulled. be able to.

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  • Heart & Thoracic Surgery (AREA)
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Abstract

La présente invention concerne un dispositif médical comprenant : une mâchoire comportant une partie de préhension ; et une lame qui peut être amenée à se rapprocher et à s'éloigner de la partie de préhension, s'étend d'une partie pointe à une partie d'extrémité de base, et comporte une partie supérieure qui comprend un bord au niveau d'une position à l'opposé de la partie de préhension, le rayon de courbure de la partie supérieure au niveau de la partie pointe étant supérieur au rayon de courbure de la partie supérieure au niveau de la partie d'extrémité de base.
PCT/JP2016/061589 2015-04-13 2016-04-08 Dispositif médical Ceased WO2016167197A1 (fr)

Priority Applications (5)

Application Number Priority Date Filing Date Title
EP16779988.1A EP3284431A4 (fr) 2015-04-13 2016-04-08 Dispositif médical
CN201680021868.7A CN107530120B (zh) 2015-04-13 2016-04-08 医疗器械
JP2016556336A JP6125117B2 (ja) 2015-04-13 2016-04-08 医療機器
US15/726,735 US20180036023A1 (en) 2015-04-13 2017-10-06 Medical instrument
US16/432,235 US20190282252A1 (en) 2015-04-13 2019-06-05 Medical instrument

Applications Claiming Priority (2)

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JP2015-081970 2015-04-13
JP2015081970 2015-04-13

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US15/726,735 Continuation US20180036023A1 (en) 2015-04-13 2017-10-06 Medical instrument

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WO2016167197A1 true WO2016167197A1 (fr) 2016-10-20

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US (2) US20180036023A1 (fr)
EP (1) EP3284431A4 (fr)
JP (1) JP6125117B2 (fr)
CN (1) CN107530120B (fr)
WO (1) WO2016167197A1 (fr)

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WO2018087838A1 (fr) * 2016-11-09 2018-05-17 オリンパス株式会社 Dispositif médical
WO2018092278A1 (fr) * 2016-11-18 2018-05-24 オリンパス株式会社 Outil de traitement par énergie
WO2019123532A1 (fr) * 2017-12-19 2019-06-27 オリンパス株式会社 Outil de traitement thermique
WO2019150496A1 (fr) * 2018-01-31 2019-08-08 オリンパス株式会社 Procédé de fabrication d'un outil de traitement et outil de traitement
CN112423688A (zh) * 2018-07-18 2021-02-26 奥林巴斯株式会社 处置器具

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WO2018087838A1 (fr) * 2016-11-09 2018-05-17 オリンパス株式会社 Dispositif médical
WO2018092278A1 (fr) * 2016-11-18 2018-05-24 オリンパス株式会社 Outil de traitement par énergie
WO2019123532A1 (fr) * 2017-12-19 2019-06-27 オリンパス株式会社 Outil de traitement thermique
WO2019150496A1 (fr) * 2018-01-31 2019-08-08 オリンパス株式会社 Procédé de fabrication d'un outil de traitement et outil de traitement
CN112423688A (zh) * 2018-07-18 2021-02-26 奥林巴斯株式会社 处置器具
JPWO2020016974A1 (ja) * 2018-07-18 2021-07-15 オリンパス株式会社 処置具及び処置システム
JP7055875B2 (ja) 2018-07-18 2022-04-18 オリンパス株式会社 処置具及び処置システム

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Publication number Publication date
US20190282252A1 (en) 2019-09-19
EP3284431A4 (fr) 2018-12-12
EP3284431A1 (fr) 2018-02-21
CN107530120A (zh) 2018-01-02
JPWO2016167197A1 (ja) 2017-04-27
JP6125117B2 (ja) 2017-05-10
US20180036023A1 (en) 2018-02-08
CN107530120B (zh) 2020-11-10

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